Provider Demographics
NPI:1265777395
Name:WISDOM CENTER FOUNDATION
Entity type:Organization
Organization Name:WISDOM CENTER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:818-231-4283
Mailing Address - Street 1:PO BOX 8443
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91409-8443
Mailing Address - Country:US
Mailing Address - Phone:818-231-4283
Mailing Address - Fax:818-627-0551
Practice Address - Street 1:5800 GRAVES AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1443
Practice Address - Country:US
Practice Address - Phone:818-231-4283
Practice Address - Fax:818-627-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care